| 2015 (new version) |
2016 (newest version) |
Type of Change |
Reason for Change |
Burden Change |
| Introduction - Describes why we are releasing the guidance and overall goals of the guide |
Introduction - Adds reference to regulatory requirement for capitation rates to be actuarially sound, to be certified by an actuary that meets standards set forth in 42 CFR §438.6, appropriate for the covered population and services for the period that the rates are effective, and have been developed in accordance with generally accepted actuarial practices and principles. |
Rev |
Providing further clarification |
No |
| Section I - Describes the expectations of all Medicaid managed care actuarial certifications |
Section I - Clarifies rate certification and supporting documentation to be submitted with attestation, including the actuarial report, other reports, letters, memorandums, and communications, and other workbooks or data. |
Rev |
Providing further clarification for data requirements. |
May slightly increase data reporting burden for states. |
|
Section I - Added references to Actuarial Standards of Practices for which actuaries developing rates must follow. |
Rev |
Providing further clarification |
May slightly increase data reporting burden for states. |
|
Section I.1: General Information - Provided more detailed description around documentation expectations of states to provide throughout the certification process. |
Del |
Providing further clarification for data requirements. |
May slightly increase data reporting burden for states. |
|
Section I.4: Pass Through Payments - Provides descriptions of pass-through payments, certification requirements, and supplemental payment requirements. |
Add |
Providing further clarification |
May slightly increase data reporting burden for states. |
|
Section II: Managed Care Rate with Long Term Services and Supports (MLTSS) - Provides additional considerations for states with MLTSS programs or programs that include MLTSS benefits |
Add |
Providing further clarification |
May slightly increase data reporting burden for states. |
| Section II - Describes expectations around actuarial certification related to the Medicaid Expansion population |
Section III: Provides further clarification to what was described in Section II of the 2015 guide about expectations of the expansion group considering this would be the third year of expansion for some states. |
Rev |
Providing further clarification |
No |
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